{"paper_id":"2a8b87fb-b883-4a36-850b-4fabb818069c","body_text":"Abstract\nPurpose\nTo examine whether the presence of peritoneal adhesions at the second cesarean delivery (CD), attributable to the first CD, are associated with maternal intra-operative organ injury and adverse neonatal outcomes.\nMethods\nA retrospective cohort study was conducted, comparing severe maternal intra-operative organ injury and adverse neonatal outcomes, between women with and without peritoneal adhesions. All women with two CDs during the follow-up period were included. Women with adhesions diagnosed during the first CD, history of other abdominal or pelvic surgery, pelvic infection or pelvic inflammatory disease, endometriosis, uterine Mullerian anomalies and newborns with known chromosomal or structural abnormalities were excluded, resulting in 7925 women. Intra-operative peritoneal organ injury was defined as a composite of bladder injury, ureteral injury, small bowel injury or hysterectomy. The examined adverse neonatal outcomes were low 1 and 5 min Apgar scores, intrapartum death (IPD) and postpartum death (PPD). Multivariate logistic regression was performed.\nResults\nPeritoneal adhesions at the second CD, attributable to the first CD were diagnosed in 32.6% of patients (n = 2581). The presence of peritoneal adhesions was not found to be independently associated with intra-operative organ injury nor with 5 min Apgar scores, IPD and PPD. Second CDs complicated with adhesions were found to be associated with low (< 7) 1 min Apgar scores (adjusted OR 1.38, CI 1.20–1.58, p < 0.001).\nConclusion\nAdhesions attributable to a previous CD do not seem to increase the risk for intra-operative organ injury and adverse neonatal outcomes. These findings may assist in reassuring patients who are facing a second CD.\nSimilar content being viewed by others\nReferences\nMacDorman M, Declercq E, Menacker F (2011) Recent trends and patterns in Cesarean and Vaginal Birth After Cesarean (VBAC) deliveries in the United States. Clin Perinatol 38:179–192. https://doi.org/10.1016/j.clp.2011.03.007\nKessous R, Sergienko R, Sheiner E (2020) Tubal ligation during cesarean delivery and future risk for ovarian cancer: a population-based cohort study. Arch Gynecol Obstet 301:1473–1477. https://doi.org/10.1007/s00404-020-05547-w\nPractice Committee of the American Society for Reproductive Medicine in collaboration with the Society of Reproductive Surgeons (2013) Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: a committee opinion. Fertil Steril 99:1550–1555. https://doi.org/10.1016/j.fertnstert.2013.02.031\nSandoval P, Jiménez-Heffernan JA, Guerra-Azcona G et al (2016) Mesothelial-to-mesenchymal transition in the pathogenesis of post-surgical peritoneal adhesions. J Pathol 239:48–59. https://doi.org/10.1002/path.4695\nLiakakos T, Thomakos N, Fine PM et al (2001) Peritoneal adhesions: etiology, pathophysiology, and clinical significance-recent advances in prevention and management. Dig Surg 18:260–273\nDiamond MP, Freeman ML (2001) Clinical implications of postsurgical adhesions. Hum Reprod Update 7:567–576. https://doi.org/10.1093/humupd/7.6.567\nLower AM, Hawthorn RJ, Ellis H et al (2000) The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the surgical and clinical adhesions research study. Br J Obstet Gynaecol 107:855–862. https://doi.org/10.1111/j.1471-0528.2000.tb11083.x\nMorales KJ, Gordon MC, Bates GW Jr (2007) Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol 196:461.e1–6. https://doi.org/10.1016/j.ajog.2006.12.017\nAwonuga AO, Fletcher NM, Saed GM, Diamond MP (2011) Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci 18:1166–1185. https://doi.org/10.1177/1933719111414206\nHellebrekers BW, Kooistra T (2011) Pathogenesis of postoperative adhesion formation. Br J Surg 98:1503–1516. https://doi.org/10.1002/bjs.7657\nSaed GM, Diamond MP (2004) Molecular characterization of postoperative adhesions: the adhesion phenotype. J Am Assoc Gynecol Laparosc 11:307–314. https://doi.org/10.1016/S1074-3804(05)60041-2\nVipond MN, Whawell SA, Thompson JN, Dudley HA (1990) Peritoneal fibrinolytic activity and intra-abdominal adhesions. Lancet 335:1120–1122. https://doi.org/10.1016/0140-6736(90)91125-T\nSzecsi PB, Jørgensen M, Klajnbard A et al (2010) Haemostatic reference intervals in pregnancy. Thromb Haemost 103:718–727. https://doi.org/10.1160/TH09-10-0704\nTulandi T, Agdi M, Zarei A et al (2009) Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 201:56.e1–6. https://doi.org/10.1016/j.ajog.2009.04.039\nEllis H, Moran BJ, Thompson JN et al (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480. https://doi.org/10.1016/s0140-6736(98)09337-4\nVrijland WW, Jeekel J, Van Geldorp HJ et al (2003) Abdominal adhesions: intestinal obstruction, pain, and infertility. Surg Endosc 17:1017–1022. https://doi.org/10.1007/s00464-002-9208-9\nRay NF, Denton WG, Thamer M et al (1998) Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg 186:1–9. https://doi.org/10.1016/S1072-7515(97)00127-0\nMarana R, Catalano GF, Muzii L (2003) Salpingoscopy. Curr Opin Obstet Gynecol 15:333–336. https://doi.org/10.1097/01.gco.0000084245.09900.dd\nvan Goor H (2007) Consequences and complications of peritoneal adhesions. Colorectal Dis 9:25–34. https://doi.org/10.1111/j.1463-1318.2007.01358.x\nten Broek RP, Strik C, Issa Y et al (2013) Adhesiolysis-related morbidity in abdominal surgery. Ann Surg 258:98–106. https://doi.org/10.1097/SLA.0b013e31826f4969\nDavey AK, Maher PJ (2007) Surgical adhesions: a timely update, a great challenge for the future. J Minim Invasive Gynecol 14:15–22. https://doi.org/10.1016/j.jmig.2006.07.013\nWalfisch A, Beloosesky R, Shrim A, Hallak M (2014) Adhesion prevention after cesarean delivery: evidence, and lack of it. Am J Obstet Gynecol 211:446–452. https://doi.org/10.1016/j.ajog.2014.05.027\nArlier S, Seyfettinoğlu S, Yilmaz E et al (2017) Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section. Arch Gynecol Obstet 295:303–311\nRossouw JN, Hall D, Harvey J (2013) Time between skin incision and delivery during cesarean. Int J Gynecol Obstet 121:82–85. https://doi.org/10.1016/j.ijgo.2012.11.008\nSoltan MH, Al Nuaima L, Khashoggi T et al (1996) Sequelae of repeat cesarean sections. Int J Gynecol Obstet 52:127–132\nMakoha FW, Felimban HM, Fathuddien MA et al (2004) Multiple cesarean section morbidity. Int J Gynecol Obstet 87:227–232. https://doi.org/10.1016/j.ijgo.2004.08.016\nGungorduk K, Asicioglu O, Celikkol O et al (2010) Iatrogenic bladder injuries during caesarean delivery: a case control study. J Obstet Gynaecol 30:667–670. https://doi.org/10.3109/01443615.2010.486086\nSikirica V, Broder MS, Chang E et al (2012) Clinical and economic impact of adhesiolysis during repeat cesarean delivery. Acta Obstet Gynecol Scand 91:719–725. https://doi.org/10.1111/j.1600-0412.2012.01395.x\nJuang J, Gabriel RA, Dutton RP et al (2017) Choice of anesthesia for cesarean delivery: an analysis of the national anesthesia clinical outcomes registry. Anesth Analg 124:1914–1917. https://doi.org/10.1213/ANE.0000000000001677\nOlutoye OA, Baker BW, Belfort MA, Olutoye OO (2018) Food and Drug Administration warning on anesthesia and brain development: implications for obstetric and fetal surgery. Am J Obstet Gyneco 218(1):98–102\nSaban A, Shoham-Vardi I, Yohay D, Weintraub AY (2019) Peritoneal adhesions are an independent risk factor for peri- and post-partum infectious morbidity. Eur J Obstet Gynecol Reprod Biol 241:60–65. https://doi.org/10.1016/j.ejogrb.2019.08.001\nAbu-Ghanem S, Sheiner E, Sherf M et al (2012) Lack of prenatal care in a traditional community: trends and perinatal outcomes. Arch Gynecol Obstet 285:1237–1242. https://doi.org/10.1007/s00404-011-2153-x\nFunding\nThis study was not funded.\nAuthor information\nAuthors and Affiliations\nContributions\nAll authors contributed to the study conception and design. AW conceived of the presented idea. AS performed the analytic calculations and wrote the manuscript with input from all authors. ISV verified the analytical methods. All authors helped shape the research and contributed to the final manuscript.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors report no conflict of interest.\nEthics statement\nThis article does not contain any studies with human participants or animals performed by any of the authors. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of SUMC institutional review board, # SOR-0146-17.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nAbout this article\nCite this article\nSaban, A., Shoham-Vardi, I., Yohay, D. et al. Peritoneal adhesions do not increase intra-operative organ injury or adverse neonatal outcomes during a repeated cesarean delivery. Arch Gynecol Obstet 302, 879–886 (2020). https://doi.org/10.1007/s00404-020-05676-2\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-020-05676-2","source_license":"public-domain-us","license_restricted":false}